Healthcare Provider Details

I. General information

NPI: 1376247924
Provider Name (Legal Business Name): NATALIE MARIE BETTEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 W 1000 N
SALT LAKE CITY UT
84116-1654
US

IV. Provider business mailing address

1455 W 2200 S STE 300
WEST VALLEY CITY UT
84119-7219
US

V. Phone/Fax

Practice location:
  • Phone: 385-261-2800
  • Fax: 877-497-4661
Mailing address:
  • Phone: 385-261-2800
  • Fax: 877-497-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14284475-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: